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Francesco Cosentino - One of the best experts on this subject based on the ideXlab platform.
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diabetes and Vascular Disease pathophysiology clinical consequences and medical therapy part i
European Heart Journal, 2013Co-Authors: Francesco Paneni, Joshua A Beckman, Mark A Creager, Francesco CosentinoAbstract:In part II of this review, we describe the epidemiology and clinical consequences of Vascular Disease in patients with diabetes, and discuss the efficacy of risk factor modification and antiplatelet treatment. Specifically, evidence-based cardioVascular therapies are discussed through novel clinical insights on management of hyperglycaemia, hypertension, dyslipidaemia as well as platelet dysfunction. Recent trends in the incidence and outcomes of Vascular Disease in diabetes suggest that timely and effective implementation of therapies is making a favourable impact.
Mark A Adelman - One of the best experts on this subject based on the ideXlab platform.
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diabetes mellitus is a coronary heart Disease risk equivalent for peripheral Vascular Disease
American Heart Journal, 2017Co-Authors: Jonathan D Newman, Caron B Rockman, Mikhail Kosiborod, Yu Guo, Hua Zhong, Howard Weintraub, Arthur Schwartzbard, Mark A Adelman, Jeffrey S BergerAbstract:Background Diabetes mellitus (diabetes) is associated with significantly increased risk of peripheral Vascular Disease. Diabetes is classified as a coronary heart Disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for peripheral Vascular Disease. The objective was to evaluate the odds of peripheral arterial Disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD, or both, compared with participants without diabetes or CHD, in a nationwide Vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS. Methods A cross-sectional analysis of all eligible Life Line Screening Inc participants age 30 to 90 years with ankle brachial indices for PAD (ankle brachial index Results Diabetes and CHD were present in 372,330 (10.7%) and 182,760 (5.8%) of participants, respectively; PAD and CAS were present in 155,000 (4.4%) and 130,347 (3.7%) of participants. After multivariable adjustment, PAD odds were 1.56 (95% CI 1.54-1.59) and 1.69 (95% CI 1.65-1.73) for participants with diabetes or CHD, respectively. Participants with both diabetes and CHD had 2.75-fold increased odds of PAD (95% CI 2.66-2.85). Findings were similar for CAS; compared with no diabetes or CHD, CAS odds increased for participants with diabetes alone (1.53, 95% CI 1.50-1.56), CHD alone (1.72, 95% CI 1.68-1.76), and both diabetes and CHD (2.57, 95% CI 2.49-2.66). Findings were consistent for women and men. Conclusion In a large database of more than 3.5 million self-referred participants, diabetes was a CHD risk equivalent for PAD and CAS, and participants with comorbid diabetes and CHD had an especially robust association with PAD and CAS. Counseling regarding screening and prevention of peripheral Vascular Disease may be useful for patients with diabetes.
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association between advanced age and Vascular Disease in different arterial territories a population database of over 3 6 million subjects
Journal of the American College of Cardiology, 2013Co-Authors: Nazir Savji, Caron B Rockman, Yu Guo, Mark A Adelman, Adam H Skolnick, Thomas S Riles, Jeffrey S BergerAbstract:Objectives This study sought to determine the relationship between Vascular Disease in different arterial territories and advanced age. Background Vascular Disease in the peripheral circulation is associated with significant morbidity and mortality. There is little data to assess the prevalence of different phenotypes of Vascular Disease in the very elderly. Methods Over 3.6 million self-referred participants from 2003 to 2008 who completed a medical and lifestyle questionnaire in the United States were evaluated by screening ankle brachial indices 50% and abdominal aortic aneurysm (AAA) >3 cm. Participants were stratified by decade of life. Multivariate logistic regression analysis was used to estimate odds of Disease in different age categories. Results Overall, the prevalence of PAD, CAS, and AAA, was 3.7%, 3.9%, and 0.9%, respectively. Prevalence of any Vascular Disease increased with age (40 to 50 years: 2%, 51 to 60 years: 3.5%, 61 to 70 years: 7.1%, 71 to 80 years: 13.0%, 81 to 90 years: 22.3%, 91 to 100 years: 32.5%; p Conclusions There is a dramatic increase in the prevalence of PAD, CAS, and AAA with advanced age. More than 20% and 30% of octogenarians and nonagenarians, respectively, have Vascular Disease in at least 1 arterial territory.
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mr angiography in the evaluation of atherosclerotic peripheral Vascular Disease
Radiology, 2000Co-Authors: Neil M Rofsky, Mark A AdelmanAbstract:Magnetic resonance (MR) angiography of lower extremity occlusive Vascular Disease has evolved into a feasible diagnostic imaging option. The previous emphasis on time-of-flight techniques was associated with lengthy acquisition times and artifactual signal losses. Those limitations presented an obstacle to widespread clinical implementation. However, the emergence of rapid imaging sequences combined with gadolinium chelate enhancement offers time-efficient alternatives that can yield a truer representation of the Vascular anatomic structure. The technology is now poised to serve as a routine screening study, provided that radiologists understand all factors needed to generate clinically relevant MR angiograms. This article is intended to provide a useful resource directed toward achieving that understanding.
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peripheral Vascular Disease evaluated with reduced dose gadolinium enhanced mr angiography
Radiology, 1997Co-Authors: Neil M Rofsky, Mark A Adelman, Glyn Johnson, Robert J Rosen, Glenn A Krinsky, Jeffrey C WeinrebAbstract:PURPOSE: To demonstrate the utility of low-dose gadolinium-enhanced magnetic resonance (MR) angiography of two consecutive anatomic areas for assessment of peripheral Vascular Disease. MATERIALS AND METHODS: Fifteen patients underwent gadolinium-enhanced MR angiography for evaluation of lower extremity peripheral Vascular Disease after conventional digital subtraction angiography (DSA). MR angiography was performed with three-dimensional coronal gradient-echo acquisitions before and during administration of gadopentetate dimeglumine. Two separate, contiguous areas were studied with separate doses of 0.075 and 0.1 mmol/kg gadopentetate dimeglumine. MR angiography findings were compared with DSA findings; DSA was the standard of reference. Treatment options were determined first with MR angiograms and then with DSA images. RESULTS: For distinguishing greater than 50% stenosis from 50% or less stenosis, gadolinium-enhanced MR angiography yielded a sensitivity of 97%, a specificity of 96%, and an accuracy of 97%. In 146 (97%) of 150 anatomic segments, there was essential or total agreement on treatments determined with MR angiography and DSA. In two cases (one case of Vascular stent placement and one case of surgical anastomosis), extent of Disease was overestimated with MR angiography. The MR study of one infrapopliteal area was insufficient for evaluation. CONCLUSION: Accurate gadolinium-enhanced MR angiography of multiple peripheral Vascular areas of the lower extremities can be performed in most patients with less than 0.2 mmol/kg contrast material.
David W Johnson - One of the best experts on this subject based on the ideXlab platform.
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impact of diabetes mellitus on the association of Vascular Disease before transplantation with long term transplant and patient outcomes after kidney transplantation a population cohort study
American Journal of Kidney Diseases, 2018Co-Authors: David W Johnson, Carmel M Hawley, Elaine M Pascoe, Germaine WongAbstract:Background Advances in kidney transplantation have led to considerable improvements in short-term transplant and patient outcomes, but there are few data regarding long-term transplant outcomes in patients with Vascular comorbid conditions. This study examined the association of Vascular Disease before transplantation with transplant and patient survival after transplantation and evaluated whether this association was modified by diabetes. Study Design All deceased donor kidney transplant recipients recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for 1990 to 2012. Predictor Vascular Disease burden. Outcomes All-cause mortality and overall transplant loss. Potential interactions between diabetes and Vascular Disease for mortality and transplant loss were assessed using 2-way interaction terms. Results Of 7,128 recipients with 58,120 patient-years of follow-up, 854 (12.0%) and 263 (3.7%) had Vascular Diseases at 1 and 2 or more sites, respectively. Overall survival for recipients without Vascular Disease 15 years after transplantation was 65% compared with 35% and 22% among recipients with Vascular Disease at 1 and 2 or more sites, respectively ( P P P P P P for interaction Limitations Selection bias and unmeasured residual confounders, such as the severity/extent of comorbid conditions likely to be present. Conclusions The impact of Vascular Disease on long-term outcomes was modified by the presence of diabetes, whereby excess risks for death and transplant loss are more apparent in recipients without diabetes.
Borge G Nordestgaard - One of the best experts on this subject based on the ideXlab platform.
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loss of function mutations in apoc3 and risk of ischemic Vascular Disease
The New England Journal of Medicine, 2014Co-Authors: Anders Berg Jorgensen, Borge G Nordestgaard, Ruth Frikkeschmidt, Anne TybjaerghansenAbstract:Background High plasma levels of nonfasting triglycerides are associated with an increased risk of ischemic cardioVascular Disease. Whether lifelong low levels of nonfasting triglycerides owing to mutations in the gene encoding apolipoprotein C3 (APOC3) are associated with a reduced risk of ischemic cardioVascular Disease in the general population is unknown. Methods Using data from 75,725 participants in two general-population studies, we first tested whether low levels of nonfasting triglycerides were associated with reduced risks of ischemic Vascular Disease and ischemic heart Disease. Second, we tested whether loss-of-function mutations in APOC3, which were associated with reduced levels of nonfasting triglycerides, were also associated with reduced risks of ischemic Vascular Disease and ischemic heart Disease. During follow-up, ischemic Vascular Disease developed in 10,797 participants, and ischemic heart Disease developed in 7557 of these 10,797 participants. Results Participants with nonfasting triglyceride levels of less than 1.00 mmol per liter (90 mg per deciliter) had a significantly lower incidence of cardioVascular Disease than those with levels of 4.00 mmol per liter (350 mg per deciliter) or more (hazard ratio for ischemic Vascular Disease, 0.43; 95% confidence interval [CI], 0.35 to 0.54; hazard ratio for ischemic heart Disease, 0.40; 95% CI, 0.31 to 0.52). Heterozygosity for loss-of-function mutations in APOC3, as compared with no APOC3 mutations, was associated with a mean reduction in nonfasting triglyceride levels of 44% (P<0.001). The cumulative incidences of ischemic Vascular Disease and ischemic heart Disease were reduced in heterozygotes as compared with noncarriers of APOC3 mutations (P = 0.009 and P = 0.05, respectively), with corresponding risk reductions of 41% (hazard ratio, 0.59; 95% CI, 0.41 to 0.86; P = 0.007) and 36% (hazard ratio, 0.64; 95% CI, 0.41 to 0.99; P = 0.04). Conclusions Loss-of-function mutations in APOC3 were associated with low levels of triglycerides and a reduced risk of ischemic cardioVascular Disease. (Funded by the European Union and others.)
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cytochrome p450 1b1 and 2c9 genotypes and risk of ischemic Vascular Disease cancer and chronic obstructive pulmonary Disease
Current Vascular Pharmacology, 2012Co-Authors: Diljit Kaurknudsen, Stig E Bojesen, Borge G NordestgaardAbstract:The aim of this review is to summarize present knowledge of genetic variation in cytochrome P450 1B1 (CYP1B1) and 2C9 (CYP2C9) genes and risk of tobacco-related cancer, female cancer, chronic obstructive pulmonary Disease and ischemic Vascular Disease. The CYP1B1 and CYP2C9 enzymes metabolize polycyclic aromatic hydrocarbons found in tobacco smoke and thereby generate Disease-causing metabolites suggested to be important in tobacco-related Diseases. Furthermore, CYP1B1 also metabolizes estrogen while CYP2C9 metabolizes arachidonic acid, both creating metabolites potentially important in risk of female cancer or ischemic Vascular Disease. Genetic variation in genes coding for CYP1B1 and CYP2C9 enzymes have shown altered enzyme activity affecting levels of metabolites and thus potentially risk of Disease. So far, however, findings have been inconsistent. Recently, large studies on the association between genetic variation in CYP1B1 and CYP2C9 and risk of Disease with considerable statistical power rebutted the hypotheses that these genetic variants affect risk of tobacco-related cancer, female cancer, chronic obstructive pulmonary Disease and ischemic Vascular Disease.
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genetically elevated c reactive protein and ischemic Vascular Disease
The New England Journal of Medicine, 2008Co-Authors: Jeppe Zacho, Anne Tybjaerghansen, Jan Skov Jensen, Peer Grande, Henrik Sillesen, Borge G NordestgaardAbstract:Background Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart Disease and ischemic cerebroVascular Disease. We tested whether this is a causal association. Methods We studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart Disease developed and 741 in whom ischemic cerebroVascular Disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart Disease and 1483 had ischemic cerebroVascular Disease. Finally, we compared 2238 patients with ischemic heart Disease with 4474 control subjects and 612 patients with ischemic cerebroVascular Disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms. Results The risk of ischemic heart Disease and ischemic cerebroVascular Disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart Disease and up to 25% for ischemic cerebroVascular Disease. However, these genotype combinations were not associated with an increased risk of ischemic Vascular Disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart Disease. Conclusions Polymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic Vascular Disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic Vascular Disease.
Carmel M Hawley - One of the best experts on this subject based on the ideXlab platform.
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impact of diabetes mellitus on the association of Vascular Disease before transplantation with long term transplant and patient outcomes after kidney transplantation a population cohort study
American Journal of Kidney Diseases, 2018Co-Authors: David W Johnson, Carmel M Hawley, Elaine M Pascoe, Germaine WongAbstract:Background Advances in kidney transplantation have led to considerable improvements in short-term transplant and patient outcomes, but there are few data regarding long-term transplant outcomes in patients with Vascular comorbid conditions. This study examined the association of Vascular Disease before transplantation with transplant and patient survival after transplantation and evaluated whether this association was modified by diabetes. Study Design All deceased donor kidney transplant recipients recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) for 1990 to 2012. Predictor Vascular Disease burden. Outcomes All-cause mortality and overall transplant loss. Potential interactions between diabetes and Vascular Disease for mortality and transplant loss were assessed using 2-way interaction terms. Results Of 7,128 recipients with 58,120 patient-years of follow-up, 854 (12.0%) and 263 (3.7%) had Vascular Diseases at 1 and 2 or more sites, respectively. Overall survival for recipients without Vascular Disease 15 years after transplantation was 65% compared with 35% and 22% among recipients with Vascular Disease at 1 and 2 or more sites, respectively ( P P P P P P for interaction Limitations Selection bias and unmeasured residual confounders, such as the severity/extent of comorbid conditions likely to be present. Conclusions The impact of Vascular Disease on long-term outcomes was modified by the presence of diabetes, whereby excess risks for death and transplant loss are more apparent in recipients without diabetes.
